Basic Information
| Provider Information | |||||||||
| NPI: | 1962476036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC CENTER OF MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 S DURANGO DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891179186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023661655 | ||||||||
| FaxNumber: | 7023854955 | ||||||||
| Practice Location | |||||||||
| Address1: | 3012 S DURANGO DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891179186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023660640 | ||||||||
| FaxNumber: | 7023669075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7023660640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 1456LIC4 | NV | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.